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If you have not participated in a particular behavior, please circle NA. Ratings: 1 2 3 4 5 NA Close supervision Moderate Minimal Not Supervision Supervision Applicable A. General professional behaviors… On time for appointments and/or meeting 1 2 3 4 5 NA Preparation and organization 1 2 3 4 5 NA Timely submission of written reports 1 2 3 4 5 NA Professional attitude 1 2 3 4 5 NA Professional appearance 1 2 3 4 5 NA Receptiveness to supervision 1 2 3 4 5 NA Comments: B. How competent do you feel in… Using formal and informal assessment measures to define problem areas, strengths, and needs of individuals, groups, and systems? 1 2 3 4 5 NA Using data to measure the outcomes of decisions and interventions? 1 2 3 4 5 NA Using scientific knowledge and research to select, develop, and evaluate interventions? 1 2 3 4 5 NA Comments: C. How competent do you feel in… Understanding the key features of and influences on child development, mental health, and psychopathology? 1 2 3 4 5 NA Understanding the knowledge of social and physiological influences on behavior? 1 2 3 4 5 NA Understanding learning theory and cognition? 1 2 3 4 5 NA Comments: Ratings: 1 2 3 4 5 NA Close supervision Moderate Minimal Not Supervision Supervision Applicable D. How competent do you feel in… Listening to and understanding the perspectives of others in professional relationships? 1 2 3 4 5 NA Communicating effectively orally? 1 2 3 4 5 NA Communicating effectively in writing? 1 2 3 4 5 NA Conducting problem solving consultations with parents, teachers, administrators, and others? 1 2 3 4 5 NA Facilitating collaboration and partnerships among key people or groups involved with a particular case? 1 2 3 4 5 NA Comments: E. How competent do you feel in… Implementing wellness and prevention programs in order to enhance the cognitive and social skills of children? 1 2 3 4 5 NA Implementing a variety of research-based interventions in order to correct and improve children’s cognitive and social skills? 1 2 3 4 5 NA Providing counseling services for students having learning problems? 1 2 3 4 5 NA Providing counseling services for students having adjustment problems? 1 2 3 4 5 NA Comments: F. How competent do you feel in… Understanding the unique and complex array of cultural influences on individual development? 1 2 3 4 5 NA Working with individuals from a variety of cultural backgrounds by considering culture-related challenges, strengths, and resources? 1 2 3 4 5 NA Comments: G. How competent do you feel in… Understanding the structure, operation, and influence of key systems (school, peers, family) in the lives of children and adolescents? 1 2 3 4 5 NA Providing system-level programmatic consultation and intervention services? 1 2 3 4 5 NA Comments: H. How competent do you feel in… Using research design and statistics knowledge to effectively evaluate studies in the professional literature? 1 2 3 4 5 NA Ratings: 1 2 3 4 5 NA Close supervision Moderate Minimal Not Supervision Supervision Applicable Conducting research from initial design through evaluation in order to contribute to school psychology’s empirical knowledge base? 1 2 3 4 5 NA Conducting research on the effectiveness of your own work? 1 2 3 4 5 NA Conducting program evaluation research? 1 2 3 4 5 NA Comments: I. How competent do you feel in… Understanding the appropriate legal, ethical, and professional standards pertaining to the practice of school psychology? 1 2 3 4 5 NA Understanding the major factors impacting the profession of school psychology and advocating for the profession in order to preserve and protect the welfare of children and others? 1 2 3 4 5 NA Promoting and ensuring appropriate and high quality services for children and other clients? 1 2 3 4 5 NA Taking responsibility for continuing professional development? 1 2 3 4 5 NA Comments: Please approximate the percentage of time that you spent in the following activities: Psycho-educational assessment Consultation Psychological assessment Crisis Intervention Neuropsychological assessment Program development Individual/group therapy Program evaluation Family therapy Preventative intervention Work with unique population Early intervention Behavior Plans / FBA Other I have reviewed these ratings with my practicum / internship supervisor. Student Date I have reviewed these ratings with the practicum / internship student. 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